As technology has grown more powerful the size and costs related to the purchasing and maintenance of computer equipment have steadily decreased. As a result computers have come to play an ever-increasing role in medical rehabilitation service delivery models. 1, 2 They are currently used for a broad range of purposes such as to administer assessment batteries, deliver therapeutic interventions, manage scheduling, and collect documentation. In both clinical and research applications the ability for a computer to collect and present information that is more accurate and dynamic has major significance. 3 This ties not only to current trends in healthcare toward evidence-based practice and electronic medical records, but also relates to shortened lengths of stay and limits on treatment time necessitated by managed care and the Prospective Payment System. 4, 5
Some of the earliest work related to integrating computers into rehab was in the area of cognitive testing and treatment. For such cases, computers have allowed for improved accuracy, speed, time efficiency, and cost effectiveness over traditional paper-based methods. 6-10 These benefits, first demonstrated in the 1960's, still hold true today and with advancements in technology, they are now even more dramatic. Using commercially available devices the researcher or clinician can, for example, easily record measures such as reaction time with greater than millisecond accuracy, secure electronic files with handwriting or fingerprint recognition, or access entire libraries worth of information with the click of a mouse.
While a survey of current literature finds many references to the use of computers in medical informatics, the majority of articles describe automated methods of patient management (e.g. scheduling, billing, documentation) and clinician-focused applications (e.g. electronic drug references, decision making tools). 11-16 There is a clear lack of research detailing the use of state-of-the-art technologies in delivering interactive treatments directly to patients. In medical rehabilitation, there are only a small number of commercial software packages currently available that are designed to be used directly by patients. For the most part, these are rather limited in both the scope of the treatment material they include as well as in their usability and software design. There is a clear need for applications that apply the advantages of computer-based systems to direct patient treatment. In order for these interactive user-interfaces to be effective in health care environments, they must be designed such that careful attention is given to both human factors and cognitive science principles. 17
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To this end, a current stream of work conducted in collaboration between the NRH Rehab Engineering Labs and Speech-Language Pathology (SLP) service, and funded jointly by the ATRC and the RERC on Telerehab, is investigating the use of computers as a tool for providing cognitive and communicative treatment, including both diagnostic assessments and therapeutic interventions (Figure 1).
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Figure 1. SLP treatment material on a tablet computer |
Over the past 4 years a “digital library” of SLP treatment material has been created. This software contains a vast array of computerized versions of existing paper-based treatment material, such as photocopied worksheets and flashcards. that address impairments in areas such as reading, memory, reasoning, and functional math. The “digital library” extends the concept of the traditional photocopied pages by making them more engaging and flexible.
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Figure 2. SLP treatment material on a tablet computer
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The “digital library” software has been installed on two tablet computers and is currently being used by NRH inpatient and outpatient SLPs with a broad range of clients. To date, 17 SLPs have used the software in more than 200 treatment sessions with close to 100 individual clients. Clients interact naturally with material on the tablet computer by “writing” with the stylus much as they would use a pencil or pen with a piece of paper. The primary benefit to using these highly portable and lightweight tablet computers is that clinicians can take the software to the clients rather than requiring them to take the clients to a computer (Figure 2). |
In planning future directions for this stream of work, focus groups were conducted in fall 2003 with the NRH SLP service to collect feedback on future applications for computers in the area of SLP as well as ways in which the current software can be expanded. The project proposed here is structured so as to address several of the key recommendations made by the SLPs. Most significantly, the SLPs suggested emphasis be given to expanding the material currently available in the “digital library” and incorporating features and functions such as wireless internet access, multimedia audio and video, and alternative input devices. Integrating these changes into the existing system and deploying the updated software on the new breed of tablet PCs will allow clinicians to have a wider range of treatment options and capabilities available to them through a single highly-portable system.
This project will build on and extend the outcomes from the earlier work, while addressing limitations inherent in similar related systems. It will promote ongoing applications related to computerized SLP treatment and act as a foundation for future brain-injury-related clinical and research applications across a broad range of disciplines.